NPIMap

Organization Active NPI

Intercessory Counseling and Consulting Outreach Inc

  • Professional Counselor
  • S Charleston, WV
National Provider Identifier
1508473141
Registry record updated Sep 28, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
Legal business name
INTERCESSORY COUNSELING AND CONSULTING OUTREACH INC
Practice address
1113B Jefferson Rd
S Charleston, WV 25309-9780
Phone
(304) 415-5715
NPI assigned
Sep 28, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 28, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Derrick GibsonNPI 1679753842
Title
Provider
Phone
(304) 415-5715

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Professional CounselorGroup: 193400000X SINGLE SPECIALTY GROUP 101YP2500X Primary

Addresses

Primary practice location

1113B Jefferson Rd
S Charleston, WV 25309-9780

Mailing address

1113B Jefferson Rd
S Charleston, WV 25309-9780
Phone (304) 415-5715

National Provider Directory

National Provider Directory

Locations

1113B Jefferson Rd
South Charleston, WV 25309
Phone (304) 415-5715

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1601251200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1601251200000",
    "number": "1508473141",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1113B JEFFERSON RD",
            "city": "S CHARLESTON",
            "state": "WV",
            "postal_code": "253099780",
            "telephone_number": "304-415-5715"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1113B JEFFERSON RD",
            "city": "S CHARLESTON",
            "state": "WV",
            "postal_code": "253099780",
            "telephone_number": "304-415-5715"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTERCESSORY COUNSELING AND CONSULTING OUTREACH INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-09-28",
        "last_updated": "2020-09-28",
        "certification_date": "2020-09-28",
        "status": "A",
        "authorized_official_last_name": "GIBSON",
        "authorized_official_first_name": "DERRICK",
        "authorized_official_title_or_position": "PROVIDER",
        "authorized_official_telephone_number": "304-415-5715"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in S Charleston, WV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.